By Tracy Shevlin
Understanding women’s health issues, including access to care and barriers to care, is a large and complicated topic. Prince William Living talked with private practitioners as well as those in health systems management and in community clinics to learn more about women’s health challenges. At each interview, our health professionals acknowledged that smart and capable women, who run businesses and take care of their families, often fail to prioritize their own healthcare.
The old adage “An ounce of prevention is worth a pound of cure” applies to many things, including healthcare. The providers that we spoke with fully believe that self-care, including leading a healthy lifestyle and having regular check-ups, is key to staying healthy. While prevention is a topic unto itself, regular check-ups are critical in the early detection of health issues and increase the survival rates of many diseases.
Each of the healthcare professionals agreed that knowledge is essential to making good health-conscious decisions. Among the professionals we consulted were Dr. John Maddox, an Ob/Gyn in Merrifield; Elizabeth Wilkins-McKee, a therapist in Manassas; Caroline and Rebecca Sutter, nurse practitioners, who work with the Mason and Partners Clinics (MAP clinics) in the greater Manassas area; and Katherine Johnson, president, Sentara Northern Virginia Medical Center.
Self-care is not about being frivolous or going to the spa and getting a manicure. It is about knowledge and taking care of one’s own body, knowing its limits, and knowing what is normal and what is not. It is about prioritizing one’s own health in everyday things so that we can be healthy and manage the important aspects of our lives. Self-care is the reason that airline safety demonstrations request that parents put on their own oxygen masks before their child’s. It sounds simple enough, but as women, it is often not natural to care for yourself first before taking care of others.
Women’s Health and the Ob/Gyn
During her reproductive years, a woman’s obstetrician/gynecologist (Ob/Gyn) often becomes her primary doctor. Perhaps this is because of the regularity of visits during those years or getting to know the doctors, but it becomes the one medical relationship that gets established for women. Prince William Living spoke to Dr. John Maddox, who has been practicing in the Northern Virginia area for more than 34 years.
In addition to child bearing or reproductive reasons to see the doctor, Maddox said, “The regular well-woman visits are important because it is at these appointments women are screened for a number of things that affect their health.” For women in their 20s, 30s and 40s, doctors are screening for cervical cancer via the Pap smear tests. Other screenings, such as for the Human Papillomavirus, also known as HPV, also let doctors know if patients are at risk for cervical cancer. For women over 40, as the risk of cervical cancer decreases, the risks of breast cancer and endometrial cancers increase. Maddox said that these screenings are important and allow for early detection, which is key to treatment and survival.
According to the American College of Obstetricians and Gynecologists, the guidelines for screenings have changed through the years. However, not all doctors agree with the changes because a delay in screening may correspond to a delay in detection, which has been paramount to resolving women’s health issues. Also, there are exceptions to the screening guidelines, and women should work with their doctors to understand their personal screening recommendations.
Guidelines for screenings:
- Gardasil – Maddox recommended this vaccine before young women become sexually active. The vaccine is effective in preventing several types of HPV that cause cancer. The vaccine is now approved for young women up to age 26.
- Pap smears – Generally, no pap is required for women under 21 years or over 65. Pap smears were once recommended annually, but the guidelines have changed to every three years for women 21–29 and every 3–5 years for women ages 30–65.
- Mammography – Annual mammograms are recommended every year beginning at age 40. Three-dimensional imaging is a newer type of scan that allows for clearer images of dense breast tissue.
- Hormone Replacement Therapy (HRT) – Maddox said that he is not opposed to the use of HRT. In addition to
helping women manage severe menopause symptoms, Maddox said HRT does have some protective value for bones in the prevention of osteoporosis and joint pain as well as in the prevention of colorectal cancer. He said that he has seen its positive effects among his patients who use it.
- Colonoscopy – This screening is recommended at age 50 (unless there is a family history of colon cancer) and
repeated every 10 years if no polyps are detected. If polyps are removed, the recommendation for re-testing is every 1–5 years.
Women and Mental Health
While mental health is important for all people, there are some specific topics that are unique to women. From infertility issues to postpartum depression, Elizabeth Wilkins-McKee, a therapist in Manassas, specializes in helping women cope with these issues as well as handling difficult life transitions, such as divorce.
According to Wilkins-McKee, shame and stigma play a role in why some women do not reach out for help. Since the 1970s, women have been conditioned to believe they should be able to be the perfect wives, mothers, employees, etc. When women can’t meet these ideals, many feel that they are deficient and unworthy. She explained that women, more than men, feel shame when they can’t be all things to all people.
“In addition to these unrealistic expectations that women have,” Wilkins-McKee said, “there are very real psychiatric disorders associated with reproductive issues, some pre-pregnancy and some following the birth of a child.” Perinatal Mood and Anxiety Disorders (PMADs) can occur during pregnancy and up to one year postpartum. It is estimated by Postpartum Support Virginia that five percent of women experience PMAD symptoms, which can include depression, anxiety, obsessive-compulsive disorder (OCD), panic disorder, and even psychosis. These are not the same as the “baby blues,” which is a temporary condition affecting 50–80 percent of new mothers and usually resolves itself in two to three weeks without treatment.
For women, whether it’s PMAD disorders or other conditions, understanding the situation and how they got to this place is only partly helpful. “It’s nice to know that our feelings are justified,” said Wilkins-McKee, “but that, in itself, is a double-edged sword. Women rationalize that because there is a reason, perinatal hormone fluctuations or other life circumstance, they should be able to fix it themselves, they don’t need help, or they think they shouldn’t need help and that is just not always true.”
Lastly, she cautioned that people who are empathetic can unwittingly do a disservice to female friends and family when they “normalize” symptoms that might require treatment. She explained that when women finally have the courage to voice their own concerns to those near them, people might make comments like, “Of course you are depressed, you are going through a divorce; or you’re not thinking clearly because you’re exhausted from the new baby, etc.” These types of comments might prevent women from seeking treatment, and it’s important for women to know that they don’t have to suffer in their condition. There is a way out.
One resource specializing in postpartum support for women is Postpartum Support Virginia (postpartumva.org). The Arlington-based nonprofit connects women with support groups, therapists and other local resources, and suggests that the road to recovery includes the following:
- Self-Care: sleep, nutrition, exercise, time off
- Social Support
- Talk Therapy
- Medication (required in some cases when the treatments above are not sufficient).
Free Clinics in the Greater Manassas Area
While it’s true that there are three major health systems—Novant, Inova and Sentara—operating locally, it’s also true that there are access-to-care and barriers-to-care issues in our immediate area. Sisters Caroline Sutter, DNP, and Rebecca Sutter, DNP, both assistant professors at George Mason University, work with some of our area’s most vulnerable residents in the Mason and Partners (MAP) clinics.
Rebecca Sutter explained that for those who are uninsured and under-insured, cost, transportation and childcare play a role in not seeking proper medical care. To help bridge the gap in care, the Sutter sisters work with community partners to provide free clinics to help improve health outcomes. Volunteer and student nurses, as well as students in other health-related fields, run the clinics. Since 2013, the MAP clinics have been essentially “pop-up clinics” with all materials and equipment transported to their respective sites in Franconia, Falls Church and Manassas Park each day. They have also held clinic days with partnering agencies, such as the Prince William Community Services Board in Manassas and the Prince William County Health Department.
Beginning in January 2019, with assistance from a grant from the Potomac Health Foundation, the MAP clinics hope to establish a permanent home on the grounds of the Manassas Park Community Center. Rebecca Sutter said, “The grant will enable us to better meet the needs of this Health Resources and Services Administration designated medically underserved population.” Additional information about clinic hours can be found on the MAP Clinic’s website: chhs.gmu.edu/mapclinics.
Getting to Know Your Local Health Systems: Spotlight on Sentara Northern Virginia Medical Center
With all the buzz about healthcare nationally, it’s important to know that there are quality healthcare options in the local area. Each hospital system is a resource full of information as well as a home base for hundreds of doctors. According to Katherine Johnson, president of Sentara Northern Virginia Medical Center, the hospital received prestigious awards last year, including being named in the Top 15 IBM Watson Health Systems in the United States for 2018 and also being ranked number 177 in the Top 500 Employers in the United States by Forbes.
“We are so excited and proud of these accolades,” said Johnson. “Everything we do at Sentara is patient-centric. We look at each process and activity from the patient’s point of view to make sure that we are offering the best quality, extraordinary experience while utilizing superior technology.”
One way in which Sentara puts the patient first is with its Nurse Navigators and Inpatient Care Coordinator programs. For most people, dealing with doctors, insurance companies and health issues is confusing and stressful. It is a language unto itself and has processes and procedures that are new and scary for patients. That is the reason that Sentara created these programs, whichwork in tandem. According to Johnson, nurse navigators can help patients navigate treatment or recovery plan options, while care coordinators can work with doctors and the hospital system and connect people with the right resources upon their release.
In its commitment to women’s health, Sentara provides for the health of a woman at every stage of her life. Sentara has recently renovated the physical space at its Woodbridge campus to make the space more relaxing for women. It now has women-only waiting rooms in the breast cancer screening area, and the labor and delivery area has been re-designed with contemporary and newly renovated, private rooms and a state-of-the-art security system for moms and their babies. Sentara Northern Virginia Medical Center also partners with the Children’s National Health
System’s neo-natal intensive care unit (NICU) to provide the best-in-class care, close to home, for the smallest members of our community.
Sentara Northern Virginia Medical Center’s commitment to patient education is demonstrated by the availability of a variety of classes from childbirth to cancer conversations and a number of public support groups for patients and caregivers. These classes and groups connect people coping with similar situations, such as cancer, diabetes and stroke recovery. Johnson said, “We are committed to helping people restore their health through education, clinical screenings and quality healthcare services.”
Additional information on Sentara’s facilities and programs can be found on its website: sentara.com/woodbridge-virginia.
Tracy Shevlin ([email protected]) is a native Virginian and long-time Manassas area resident. She is a graduate of George Mason University where she is also an office manager. Follow her on Twitter @nvalady1.